Inconsistent Grades in Bipolar Children

The child: "I know a lot of stuff, but when I have to write it down, I lose it. I must be stupid. My brother Martin, who's two years younger than me, is a better learner. I hate math!"

There is evidence that bipolar children and adolescents (as well as children of bipolar parents, who are at high risk for developing Bipolar Disorder show particular patterns on IQ testing. Specifically, discrepancies often exist between their verbal IQs (how well they comprehend and use language) and their performance IQs (how well they perform in the areas of perceptual organization and nonverbal learning). Though the verbal IQ test measures such skills as vocabulary, abstract reasoning, and long-term memory, the performance IQ test assesses nonverbal learning skills such as spatial problem solving, visual analysis, and fine-motor skills. Pertinent to this issue is a study published in 1983 by Paolo Decina, MD, and Clarice J. Kestenbaum, MD (and others from Columbia University-affiliated programs and New York University), who looked at verbal and performance IQs in a sample of children who were at high risk for Bipolar Disorder because they were offspring of bipolar parents. Full-scale (that is, over-all IQ) and verbal IQ scores did not differ between the control group and the high-risk children, but performance IQs were significantly lower in the latter group.¹ This finding of a discrepancy between the two scores in children of parents with Bipolar Disorder has received additional support in the psychiatric literature.²

How does this transfer to real life? What I see in my practice is that many bipolar children are verbally quite skilled. If you have a conversation with them, you cannot help but be impressed by the sophistication of their words and ideas. But a red flag pops up when they go to school and their grades are not consistent with their apparent level of intelligence. Many of my children have the potential to be straight-A students if their skills weren't measured by paper-and-pencil tasks. When they can express their knowledge verbally, they do much better grade-wise. In addition, their ability to think differently does not always fit neatly into the goals of elementary and secondary school education. Sometimes, their blessings of creativity, intelligence, and individuality can interfere with their ability to get the necessary foundation in their education. Unfortunately, they may need to wait until adulthood to fully use and appreciate their special gifts.

Another pattern often emerges in IQ testing with bipolar children: Kids with depression and anxiety sometimes have periods when their verbal IQs and performance IQs are temporarily reduced—largely because their emotions interfere with their ability to reason, concentrate, and think through language-based problems. In children with either ADHD or Bipolar Disorder, performance IQ and working memory scores are often lower than might be expected. These are timed tests, and the lower scores may be attributable to the kids' impulsivity, lack of frustration tolerance, and/or slow motor processing on the day they were administered.

Ways to Help

One option is to allow the child to do some reports and assignments orally instead of requiring that they be written. Another option, if your child's teacher agrees, is for the child to dictate the homework or report to the parent, who then acts as a scribe. Using a tape recorder in class is another option, allowing the child to get the information he needs without taking notes. Some children will also require extra time on tests, so that they have enough time to show what they know.

1. P. Decina, C. J. Kestenbaum, S. Farber, et al., Clinical and psychological assessment of children of bipolar probands, American Journal of Psychiatry 140 (1983):548.
2. P. McDonough-Ryan, M. DelBello, P. K. Shear, et al., Academic andcognitive abilities in children of parents with bipolar disorder: A test of the nonverbal learning disability model, Journal of Clinical Experimental Neuropsychology 24 (2002): 280.